Mallary: The Cost Of Health Care

(HOST) Commentator Dick Mallary says some difficult questions need to be raised in the current health care overhaul discussion. Those questions have to do with the need for limits on how much care can be provided.

(MALLARY) As we labor at the state and national levels to reform the delivery of health care, there is one unpleasant truth that few are willing to discuss. That is the necessity to set limits on the care that the public can and should provide.

The cost of health care in the United States is very high and rapidly growing higher. As we assure that every citizen has appropriate health care, the cost will be even higher. At a time this country faces trillion dollar budget deficits we need to ask, how much health care can the country afford?

It is Vermont's clear policy that every citizen should have access to appropriate health care. Since many citizens do not have adequate health insurance or the personal resources to pay for their health care, they must depend upon government programs to provide or subsidize their care.

While it is not the proper business of the government to prescribe what kind or level of health care individuals may buy for themselves, it is an essential government duty to decide what kind and level of health care it will provide with taxpayer dollars. And this is where our political system has failed.

Those who are writing health reform legislation at both the national and state levels have failed to establish open and explicit guidelines as to how much health care the government will pay for. Legislation speaks of "essential benefits" that will be provided. It says that it will base its decisions on "evidence based medicine" to determine what is "medically necessary". It then delegates to a non-political entity the duty of construing what these words mean. And, if the recipients of the health care it provides are not satisfied, they will have recourse to the courts to let our judges look over the shoulders of the administrators and reverse their decisions.

This system has led in the past to very liberal interpretation of the vaguely defined benefits and little opportunity for the administrators of the program to control excessive costs.

A significant factor in the high cost of health care in the United States is that we provide a lot of very high cost care that achieves little benefit. We excel in delivering heroic but often futile procedures for patients at the end of life. We utilize cutting edge and exorbitantly expensive pharmaceuticals that are only marginally better than far cheaper generics. We provide surgical procedures for conditions that could be addressed by lifestyle changes. In some cases we mandate payment for services where there is no evidence based benefit. In sum, we spend a lot of public money for health care that may have no benefit or at least does not seem to have a benefit commensurate with its cost.

If we are to spend our massive sums of public health care dollars wisely, we need to end the political pretense that we can give everyone everything they might like. Our political leaders need to set up a system with explicit standards so that its administrators can allocate such sums as the public can afford to spend to provide the best possible care for everyone.